Think about your last visit to a health care provider. You may have been anxious about having tests run or worried about missing an afternoon’s work. But did you give even a moment’s thought to how you’d pay for that appointment?

Although for most, a visit to see a health professional is a common occurrence, for those who are uninsured, it can seem an entirely inaccessible endeavor.

To lack health insurance is not uncommon.

In South Dakota’s southeastern corner lies Clay County, the home to USD and Vermillion. According to the U.S. Census, 11.4% of Americans live in poverty, compared to 16.2% of Clay County residents who do, while approximately 11% of the county’s residents aged 65 and younger are uninsured. All this means, unsurprisingly, that many of its citizens are also without health insurance.

Despite these distressing statistics, USD School of Health Sciences leaders, faculty and students affirm that no one should be denied access to health care. Recognizing this disparity as an opportunity to help a suffering segment of South Dakotans in tandem with providing real-world experience for students, the Vermillion Community Clinic was initiated.

The free student-run clinic, held at Sanford Vermillion Clinic the second Thursday evening of every month, made its debut in January 2022. Volunteer supervisors are members of USD faculty who are also credentialed at Sanford Health. What makes the Vermillion Community Clinic unique is that its express reason for coming into existence is to serve the uninsured, in tandem with creating real-world opportunities for USD students in every health discipline to get involved firsthand.

The clinic originated with involvement from the physician assistant program and the Sanford School of Medicine, eventually expanding so that other programs—nursing, physical therapy, occupational therapy, audiology, dental hygiene, addiction counseling and social work—could play a role as well.

Katie Kassin ’06, ’08, assistant professor in USD’s physician assistant program with privileges at the Sanford Vermillion Clinic, is a faculty advisor for the Vermillion Community Clinic and occasionally assists with oversight of the students during the student-run clinic.

“In only two short years, our physician assistant students will have completed the adequate training to be competent PAs working in the field of medicine,” she said. “This is a great experience for the students as it gives them experience not only with the evaluation and management of patients, but also in learning how to work in an interprofessional setting with other members of the health care team. Additionally, as this clinic is student run, they really can see how a clinic works from an administrative standpoint as well.”

Luke Smith, a third-year medical student originally from Groton, South Dakota, is one medical student who has been involved in the clinic’s planning from the start, and he remains at the forefront of the effort. A 2019 graduate of USD’s medical biology undergraduate program, Smith participated in the Frontier And Rural Medicine (FARM) program’s Vermillion site. Both Smith and his medical school colleague, Hannah Wiley ‘22, were instrumental in leading the student and faculty meetings and launching the clinic.

A portrait of Luke Smith.

“What’s great about this clinic is that patients can get all the checkups and screenings they need, with certain logistical limitations,” Smith explained. “For example, we can’t have a full dental clinic, but we can do screenings and referrals. Sanford Vermillion covers the cost of the office visit and any lab work, immunizations or X-rays that may be warranted.”

When a patient presents to the clinic, attending medical and physician assistant students are responsible for obtaining a history and performing a physical examination. If necessary, they will order laboratory or imaging studies to help determine an accurate diagnosis. Based upon their diagnosis, they will formulate a management and treatment plan for the patients and involve other health professions students as appropriate. However, before discussing their recommendations and plan with their patient, they discuss this with their supervising provider for feedback.

Collectively, the students determine whether the patient should be seen by another discipline, either that same day or the following month when the clinic is open again.

Smith said they also continue to incorporate more health care disciplines as appropriate, using referrals when necessary. “I hope we can start connecting people with other resources in the community, such as the Welcome Table, or other services they may not be aware they are eligible for,” he said.

“The aim of the student- run clinic is to provide care to those who are uninsured,” Kassin said. “My hope is that our students gain an appreciation for what this population struggles with – how so many of them desperately need medical care but put off or avoid going to the medical office due to the lack of insurance and the expense associated with that."

“And,” she continued, “I hope that by gaining that understanding, when the students are out in the workforce themselves, they remember this experience and give back to those in need in the communities in which they choose to practice.”

“Sanford Vermillion and USD partner once again for impactful work that not only enriches the student learning experience but breaks down barriers to health care for many in our community. The community professionals and the student leaders put into action the purpose and values that motivate health care professionals by creating this clinic to address an unmet need. This is meaningful, sustainable work,” stated Veronica Schmidt, senior director at Sanford Vermillion Medical Center.

USD Community Clinic staff and students pose together for a photo.

Although the Vermillion Community Clinic reflects similarities of the Coyote Clinic, a Sioux Falls based partnership with Avera Medical Group Health Care Clinic at its downtown Sioux Falls location, only the Vermillion Community Clinic involves health care disciplines other than medicine.

“We’ve collaborated with the Coyote Clinic to get our clinic off the ground. Much of our plan is based on how that clinic operates and we collaborate to find grants and volunteers,” explained Chris James, a third-year Doctor of Physical Therapy student who was asked by USD leadership to serve on the planning and governing board of the Vermillion Community Clinic. “But different students are involved, and that clinic only involves SSOM students, not other disciplines.”

James was well suited for his position on the board, as throughout his college career, he has attended pro bono network conferences and is a member of the Society of Student Run Free Clinics, a national organization. He serves as a liaison between that organization and the USD School of Health Sciences to cultivate the clinic’s growth and to advocate for resources that benefit patients.

“With USD’s focus on interdisciplinary communication, we work with other disciplines daily to learn what other fields do and learn how to work together,” James said. “The creation of this clinic has been a long process that has taken a lot of patience and communication to get it off the ground. USD prepared me to feel confident and be a good advocate for our profession.”

James indicated that the Vermillion Community Clinic benefits him just as much as he has put into it: “I get to be part of an incredible project and give back to Vermillion and invest back in the community that has helped me in my education.”

Although James may not get to experience working in the clinic due to his graduation date, he has laid the groundwork for many others to reap the benefits of the clinic experience. “I really want to attend at least one or two sessions, so I have that experience,” he said.

Matt Dewald, a physical therapist and assistant professor in USD’s Department of Physical Therapy, also serves as a faculty advisor for the clinic. “Our motivation is educating our community and helping those who may have barriers to education about their health,” he said. “Students will be able to make effective decisions in what assists patients to improve their health, to improve movement or lessen their pain.”

Participation in the Vermillion Community Clinic is one way health sciences students achieve their service requirements, a major portion of the school’s mission.

“Altruism, collaboration, compassion and social responsibility are all essential values for a physical therapist to have, and the Vermillion Community Clinic assists with developing all of these,” Dewald said.

James agreed. “It’s very exciting,” he said. “Vermillion and other communities with student-run clinics can make a real impact to improve health care and availability of resources. With the USD School of Health Sciences and Sanford Health collaboration, there’s no limit to where we can go.”

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